The people most likely to be affected are poor, sick and uninsured with the problem highest — 17 per cent — in British Columbia, perhaps a result of that province’s high cost of living, researchers say.

“It’s very strange that we have hospitals and physicians covered, for everybody, universally, yet prescription drugs are a complete patchwork that leaves a lot of Canadians uninsured; it’s more a historical accident than a rational policy design,” said Dr. Michael Law, of the Centre for Health Services and Policy Research, University of British Columbia (UBC).

Outpatient prescription medications fall outside the scope of the Canada Health Act, which requires provinces to provide universal public insurance for medically necessary hospital and physician services. Many Canadians do not have insurance for prescription drugs and must pay out-of-pocket for medications. Two-thirds of Canadian households incur these expenses each year, totalling $4.6 billion in 2010, or about 17.5% of total spending on prescription drugs.

Among those without drug insurance, cost-related nonadherence was reported by 26.5% compared with only 6.8% among those who reported having drug insurance.

And not filling prescriptions or skipping doses because they cannot afford their prescription medications puts people at an increased risk of adverse health outcomes, given that over half of the total spending on prescription drugs in Canada is for medications intended for long-term use, such as drugs to manage cardiovascular risk factors, says the study published Monday.

Reducing cost-related nonadherence would likely improve health and reduce spending in other areas, such as admissions to hospital for acute care, concluded the authors.

“Say if somebody is taking an antihypertensive and can afford to take it and therefore take it more regularly, then that might prevent a heart attack, and we know that once people end up in the hospital that all goes on the public purse,” explained Law.

“We think these findings are timely, with the premiers’ Council of the Federation meeting (this week) in Victoria, B.C. The country’s 13 provincial and territorial premiers should focus on how to address this disparity to improve access to prescription drugs for all Canadians.

“There really is very good evidence out there that if you were to implement some kind of universal coverage system it would actually come out to be a lot cheaper, because governments could use their collective buying power to really drive down the price of the medicines.”

The researchers from UBC, University of Toronto and the Institute for Clinical Evaluative Sciences analyzed data from 5,732 people who participated in the 2007 Canada Community Health Survey. Participants who received a prescription were asked if they had problems filling a prescription, avoided refilling a prescription or tried to make a prescription last longer because of the cost.

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